The SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 300
- 主要终点
- Urinary incontinence
研究概览
简要总结
There is a gap between research and clinical practice, leading to variability in decision-making. Clinical audits are an effective strategy for improving implementation of best practices. Quasi-experimental, multicentre, before-and-after. Primary-care and hospital-care units and associated socio-healthcare structures, and the patients attended at both. Implementation of evidence-based recommendations by application of the Getting Research into Practice model (process of improvement by reference to a prior baseline clinical audit. Data will be collected at baseline and, during the first year of follow up, at months (3, 6, 9,12)
详细描述
Aim: To assess the effectiveness of a model of implementation of evidence-based recommendations, in terms of patient outcomes and healthcare quality. Desing: Quasi-experimental, multicentre, before-and-after. Methods Primary-care and hospital-care units and associated socio-healthcare structures, and the patients attended at both. Intervention: Implementation of evidence-based recommendations by application of the Getting Research into Practice model (process of improvement by reference to a prior baseline clinical audit). Variables: Process and outcome criteria with respect to pain, urinary incontinence and fall prevention. Data will be collected at baseline and, during the first year of follow up, at months (3, 6, 9,12), with data on patients and indicators being drawn from clinical histories and records. Descriptive analysis, and comparison of the effectiveness of the intervention by means of inferential analysis and analysis of trends across follow-up. 95% confidence level. This project is funded by Spanish Strategic Health Action November 2014. Project duration 2015-2017.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Unit-inclusion criteria. The study will cover all SNHS units and associated socio-healthcare structures which voluntarily adhere to the project and undertake to implement recommendations relating to pain, urinary incontinence and prevention falls.
- •For the purposes of this study, a "unit" is defined as any service, centre or institution that delivers health services to a homogeneous group of patients who share similar characteristics.
- •Patient-inclusion criteria. The study will include all patients attended at units participating in the study, who meet the following criteria, depending on the recommendations to be implemented at each unit:
- •Pain: persons admitted to hospital centres who may potentially suffer from some type of pain. Patients will be classified according to whether they are adults or children (paediatric patients), and according to whether they experience chronic pain, acute postoperative pain, or acute pain due to other causes.
- •Incontinence: community-dwelling or institutionalised persons prone to present with urinary incontinence. Patients will be classified according to whether they are 65 years of age or over.
- •Falls: persons aged over 65 years who display one or more fall risk factors according to the assessment criteria established by the risk assessment instrument used.
排除标准
- 未提供
研究组 & 干预措施
Quasi-experimental uncontrolled, before-and-after
The intervention will consist of the use of the GRIP (Getting Research into Practice) model and implementation of its strategies in clinical practice, according to the study unit in question and the scope of action
干预措施: GRIP (Getting Research into Practice) model (Other)
结局指标
主要结局
Urinary incontinence
时间窗: 15 month
Assessment of presence of urinary incontinence. Total number of patients in whom the presence of urinary incontinence has been initially assessed, and who are registered / Total number of patients discharged in the assessment period) \* 100
Detection of pain, at admission
时间窗: 15 month
Total number of patients who have been assessed for the presence of pain and is registered / Total number of patients discharged during the measurement period) \* 100 The assessment of the presence of pain will be measured in a dichotomous variable: Yes/No. For Yes, there must be registered evidence of pain assessment with a Visual Analogic Scale (VAS; 10 cm, 0=no pain, 10=maximum pain) or Numerical rating scale (NRS; 0=no pain, 10 =worse pain), or the FLACC scale tool or paediatric patients,(Face, Leg, Activity, Cry, Consolability). Categories is scored from 0-2. Total scale: 0 is relaxed and comfortable, 1-2 Moderate discomfort, 3-6 Moderate pain and 7-10 Severe pain/discomfort f or PAINAD scale tool for patient with dementia. Measure breathing, negative vocalization, facial expression, body language and capacity for relief. Each item can get a maximum score of 2. The total scores can be from 0 (no pain) to 10 (maximum pain)
Risk of falls
时间窗: 15 month
Assessment of fall risk with a validated tool, at admission or onset of care.(Total number of patients to whom the risk of falls with a validated tool was initially assessed and registered / Total number of patients discharged during the measurement period) \* 100 The assessment of fall risk in clinical status will be measured in a dichotomous variable: Yes/No. For Yes, there must be registered evidence of fall risk with a validated tools.Tools: Hendrich II Fall Risk Model, score: 0-16. Patient without risk (0), risk (1-4 points) and high risk (\>5 points). H. Downton scale, score from 0 to 12. Patient without risk (0), low risk (1-2) and high risk (\> 3 points). Morse Falls Scale, score from 0 to 150. Patient without risk (0-25), low risk (25-50) and high risk (\> 50 points). Stratify or Stratify modified scale assesment includes five questions with dichotomous answer; obtaining two or more positive answer would classify the individual as a high risk patient to suffer a fall.
次要结局
- Age(15 month)
- Type of institution(15 month)
- Type of urinary incontinence(15 month)
- Patient education, urinary incontinence management.(15 month)
- Urinary incontinence management(15 month)
- Size of hospital unit(15 month)
- nurse/patient ratio(15 month)
- Days of stay(15month)
- Pain at admission in paediatric patient(15 month)
- Reason for admission/consultation(15 month)
- Size of primary care unit(15 month)
- Size of socio-healthcare centres(15 month)
- Impact of urinary incontinence(15 month)
- Severity of incontinence(15 month)
- Sex(15 month)
- Pain at admission in patient with dementia(15 month)
- Pain after a change in clinical status in patient with dementia(15 month)
- Pain after a change in clinical status in patient with mechanic ventilation(15 month)
- Pain assessment(15 month)
- Pain after a change in clinical status in paediatric patient(15 month)
- Pain management(15 month)
- Maximum pain(15 month)
- Prevention of falls(15 month)
- Use of restraints(15 month)
- Incidence of falls(15 month)
- Pain at admission in patient with mechanic ventilation(15 month)
- Pain after a change in clinical status in adult patientfor pain(15 month)
- Patient education in pain(15 month)
- Intensity of Pain(15 month)
- Risk after a fall(15 month)
- Falls that cause injury(15 month)
研究者
Teresa Moreno Casbas
Head Of Nursing Research Unit
Instituto de Salud Carlos III